Employment Application for Technologies Division

This Application must be filled out entirely
Your Name:*
Address:*
City:*
State:*
Zip Code:*
Primary Phone Number:*
Your Email:*
Applying for Area Location of:*
TucsonPhoenixOther (Please Specify)
Position you are applying for:*
Telecommunications TechnicianTelecommunications Wireman
List how many years of total experience you have in the electrical trade:*
Are you willing to travel out of town to work?* YesNo
List any days/hours you are UNABLE to work or reasons you might not other than sickness and why:*




For Insurance and Security Clearance Purposes
Do you have a valid Driver’s License?* YesNo
Driver's License Number:*
State:*
Expiration Date:*
Do you have a clear driving record for the last 3 years?*
YesNo
Do you have a CDL?*
YesNo
Have you had a DUI or other serious infraction on your driving record?* YesNo
If Yes, Please Explain:
Have you ever been convicted of a Felony or Misdemeanor other than a Traffic Violation? YesNo
If Yes, Please Explain:
Do you have your own personal and reliable transportation?*
YesNo
How did you hear about this job?
Have you ever worked for Kelly Energy Inc. before?*
YesNo
If Yes, When?
List any relatives or friends working for Kelly Energy Inc. now:




Personal References
Name:*
Relationship:*
Phone Number:*
Name:*
Relationship:*
Phone Number:*
Name:
Relationship:
Phone Number:



Education(s)
High Schoo:
Date Graduated:
University/College:
Date Graduated:
Degree/Major:
Military Services:*
YesNo
Branch/Dates of Service/MOS/Other Information:
Are you BICSI Certified?*
YesNo
Are you certified by another accredited program?*
YesNo



Please mark the appropriate skills you are trained/qualified to perform:


Cat 5, 5e, 5E+ and 6:
InstallationTerminationTesting
Optical Fiber
InstallationTerminationTesting
Experience with Special Systems: Fire AlarmSecurityNurse/CellProgrammable Lighting


Kelly Energy Inc. offers an accredited BICSI certification Program.


Are you interested in applying for enrollment in this program? YesNo
Please list any other schooling/skills/special training you have had:



Employment History
Employer (most current) 1:*
Supervisor's Name:*
Phone Number:*
Starting Salary:*
Ending Salary:*
Starting Date:*
Ending Date:*
Job Title:*
Duties:*
Reason(s) for Leaving:*



Employer 2:*
Supervisor's Name:*
Phone Number:*
Starting Salary:*
Ending Salary:*
Starting Date:*
Ending Date:*
Job Title:*
Duties:*
Reason(s) for Leaving:



Employer 3:
Supervisor's Name:
Phone Number:
Starting Salary:
Ending Salary:
Starting Date:
Ending Date:
Job Title:
Duties:
Reason(s) for Leaving:



Resume

Please note: A Resume does NOT take the place of this application. Any Resumes received without an application will not be considered for employment.



Applicant's Statement
I certify that my answers on this application are true and correct.

If employed, I understand that any false or misleading information or statements given in my application or during my interview may result in my immediate dismissal.

By signing below, I hereby authorize Kelly Energy Inc. to verify the information I have given on this application and to contact any previous employers and references listed on this application unless specifically noted below: (List anyone you do not want us to contact, and the reason why).



Applicant's Digital Signature:*
Date:*